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<title>Documento sin título</title>
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    <script type="text/javascript" src="jquery-latest.js"></script>
    <script type="text/javascript" src="jquery.validate.js"></script>
    <script type="text/javascript" src="inscripcion_funciones.js"></script>
    
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    <form action="registro.php" method="post" name="carga" id="carga">
<fieldset>

	<table width="948" align="center" border = "0">
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		    <td colspan="4" align="center" bgcolor="#0000FF" style="color: #FFF"><h1><strong>Formulario de Inscripción</strong></h1></td>
	      </tr>
		  <tr>
		  <td colspan="4" align="center" bgcolor="#0099FF" style="color: #FFF">DATOS PERSONALES</td>
		  </tr>
		<tr align="left">
			<td width="179">Nombres:</td>
			<td><input name="nombres" type="text" class="required" minlength="2" tabindex="1"></td>
                        <td width="238">Pais:</td>
			<td width="290"><select name="pais" id="pais" tabindex="7">
			  <option value="ARGENTINA" selected>ARGENTINA</option>
			  <option value="ALEMANIA">ALEMANIA</option>
			  <option value="AUSTRALIA">AUSTRALIA</option>
			  <option value="AUSTRIA">AUSTRIA</option>
			  <option value="BELGICA">BELGICA</option>
			  <option value="BOLIVIA">BOLIVIA</option>
			  <option value="BRASIL">BRASIL</option>
			  <option value="CANADA">CANADA</option>
			  <option value="CHILE">CHILE</option>
			  <option value="CHINA">CHINA</option>
			  <option value="COLOMBIA">COLOMBIA</option>
			  <option value="COREA">COREA</option>
			  <option value="COSTA RICA">COSTA RICA</option>
			  <option value="CROACIA">CROACIA</option>
			  <option value="CUBA">CUBA</option>
			  <option value="DINAMARCA">DINAMARCA</option>
			  <option value="ECUADOR">ECUADOR</option>
			  <option value="EL SALVADOR">EL SALVADOR</option>
			  <option value="EMIRATOS ARABES UNIDOS">EMIRATOS ARABES UNIDOS</option>
			  <option value="ESCOCIA">ESCOCIA</option>
			  <option value="ESLOVAQUIA">ESLOVAQUIA</option>
			  <option value="ESLOVENIA">ESLOVENIA</option>
			  <option value="ESPAÑA">ESPAÑA</option>
			  <option value="ESTADOS UNIDOS">ESTADOS UNIDOS</option>
			  <option value="ESTONIA">ESTONIA</option>
			  <option value="FINLANDIA">FINLANDIA</option>
			  <option value="FRANCIA">FRANCIA</option>
			  <option value="GRECIA">GRECIA</option>
			  <option value="GUATEMALA">GUATEMALA</option>
			  <option value="HOLANDA">HOLANDA</option>
			  <option value="HONDURAS">HONDURAS</option>
			  <option value="INDIA">INDIA</option>
			  <option value="INGLATERRA">INGLATERRA</option>
			  <option value="IRAN">IRAN</option>
			  <option value="IRAQ">IRAQ</option>
			  <option value="IRLANDA">IRLANDA</option>
			  <option value="ISRAEL">ISRAEL</option>
			  <option value="ITALIA">ITALIA</option>
			  <option value="JAPON">JAPON</option>
			  <option value="LETONIA">LETONIA</option>
			  <option value="LITUANIA">LITUANIA</option>
			  <option value="MEXICO">MEXICO</option>
			  <option value="NICARAGUA">NICARAGUA</option>
			  <option value="NORUEGA">NORUEGA</option>
			  <option value="NUEVA ZELANDIA">NUEVA ZELANDIA</option>
			  <option value="OTRO">OTRO</option>
			  <option value="PANAMA">PANAMA</option>
			  <option value="PARAGUAY">PARAGUAY</option>
			  <option value="PERU">PERU</option>
			  <option value="POLONIA">POLONIA</option>
			  <option value="PORTUGAL">PORTUGAL</option>
			  <option value="PUERTO RICO">PUERTO RICO</option>
			  <option value="REPUBLICA CENTRO AFRICANA">REPUBLICA CENTRO AFRICANA</option>
			  <option value="REPUBLICA DOMINICANA">REPUBLICA DOMINICANA</option>
			  <option value="RUMANIA">RUMANIA</option>
			  <option value="RUSIA">RUSIA</option>
			  <option value="SINGAPUR">SINGAPUR</option>
			  <option value="SUDAFRICA">SUDAFRICA</option>
			  <option value="SUDAN">SUDAN</option>
			  <option value="SUECIA">SUECIA</option>
			  <option value="SUIZA">SUIZA</option>
			  <option value="URUGUAY">URUGUAY</option>
			  <option value="VENEZUELA">VENEZUELA</option>
			  <option value="VIETNAM">VIETNAM</option>
	      </select></td>
			<td width="9">&nbsp;</td>
			<td width="11">&nbsp;</td>
		  </tr>
		<tr align="left">
			<td>Apellidos:</td>
			<td><input name="apellidos" type="text" class="required" minlength="2" tabindex="2"></td>
			<td>Provincia:</td>
			<td id="provincia">
	      <td>&nbsp;</td></td>
		  </tr>
		<tr align="left">
			<td>Tipo de Documento:</td>
			<td><select name="documento" tabindex="3">
			  	<option value="DNI">DNI</option>
				<option value="CEDULA DE IDENTIDAD">CEDULA DE IDENTIDAD</option>
				<option value="LC">LC</option>
				<option value="LE">LE</option>
				<option value="OTRO">OTRO</option>
				<option value="PASAPORTE">PASAPORTE</option>
			  </select>
		  </td>
			<td>Correo Electronico:</td>
			<td><input name="email" type="text" id="email" class="required email" tabindex="9"></td>
		  </tr>
		<tr align="left">
		  <td>Numero de Documento:</td>
		  <td><input name="numero_documento" type="text" class="required digits" minlength="8" maxlength="12" tabindex="4"></td>
		  <td>Por Favor Reingrese su correo</td>
		  <td><input name="emailv" type="text" class="required email" tabindex="10"></td>
		  </tr>
		<tr align="left">
		  <td>Telefono:</td>
		  <td><input name="telefono" type="text" class="digits" size="12" maxlength="12" minlength="8" tabindex="5"></td>
		  <td>Password:</td>
		  <td><input name="password" type="password" id="password" class="required" size="12" maxlength="12" minlength="5" tabindex="11"></td>
		  </tr>
		<tr align="left">
		  <td>Celular:</td>
		  <td><input name="celular" type="text" class="digits" size="12" maxlength="12" minlength="8" tabindex="6"></td>
		  <td>Por Favor Reingrese password</td>
		  <td><input name="passwordv" type="password" class="required" size="12" maxlength="12" minlength="5" tabindex="12"></td>
		  </tr>
		<tr bgcolor="#009966" style="color: #FFF">
		  <td colspan="4" align="center" bgcolor="#0099FF">FORMACIÓN PROFESIONAL</td>
		  </tr>
		<tr align="left">
			<td>Profesion:</td>
			<td><input name="profesion" type="text" class="text" minlength="2" tabindex="13"></td>
			<td>Empresa/Institucion a la que pertenece:</td>
			<td><input name="entidad" type="text" class="text" minlength="2" tabindex="16"></td>
		  </tr>
		<tr align="left">
			<td>Nivel Educativo:</td>
			<td><select name="educacion_formal" tabindex="14">
			  				<option value="DOCTORADO">DOCTORADO</option>
				<option value="MBA">MBA</option>
				<option value="MASTER">MASTER</option>
				<option value="POSTGRADO">POSTGRADO</option>
				<option value="UNIVERSITARIO">UNIVERSITARIO</option>
				<option value="TERCIARIO">TERCIARIO</option>
				<option value="SECUNDARIO">SECUNDARIO</option>
				<option value="OTRO">OTRO</option>
			  </select>
		  </td>
			<td>Actividad de la Empresa:</td>
			<td><select name="actividad" tabindex="17">
			  <option value="AERONAVEGACION">AERONAVEGACION</option>
			  <option value="AFJP">AFJP</option>
			  <option value="AGRICULTURA Y GANADERIA">AGRICULTURA Y GANADERIA</option>
			  <option value="AGROINDUSTRIA">AGROINDUSTRIA</option>
			  <option value="ALIMENTOS Y BEBIDAS">ALIMENTOS Y BEBIDAS</option>
			  <option value="ARQUITECTURA">ARQUITECTURA</option>
			  <option value="ART">ART</option>
			  <option value="ARTESANAL">ARTESANAL</option>
			  <option value="ARTISTICA">ARTISTICA</option>
			  <option value="ASOCIACION SIN FINES DE LUCRO">ASOCIACION SIN FINES DE LUCRO</option>
			  <option value="ASTILLERO">ASTILLERO</option>
			  <option value="AUTOMOTRIZ">AUTOMOTRIZ</option>
			  <option value="BANCA / FINANCIERA">BANCA / FINANCIERA</option>
			  <option value="BIENES DE CAPITAL">BIENES DE CAPITAL</option>
			  <option value="BIOTECNOLOGIA">BIOTECNOLOGIA</option>
			  <option value="CEREALERA">CEREALERA</option>
			  <option value="COMERCIO">COMERCIO</option>
			  <option value="COMERCIO EXTERIOR">COMERCIO EXTERIOR</option>
			  <option value="CONGRESOS">CONGRESOS</option>
			  <option value="CONSTRUCCION">CONSTRUCCION</option>
			  <option value="CONSULTORIA / AUDITORIA">CONSULTORIA / AUDITORIA</option>
			  <option value="CONSUMO MASIVO">CONSUMO MASIVO</option>
			  <option value="CONTABILIDAD">CONTABILIDAD</option>
			  <option value="CORREO">CORREO</option>
			  <option value="COSMETICA">COSMETICA</option>
			  <option value="CURTIEMBRE">CURTIEMBRE</option>
			  <option value="DEFENSA">DEFENSA</option>
			  <option value="DEPORTES">DEPORTES</option>
			  <option value="DISCOGRAFIA">DISCOGRAFIA</option>
			  <option value="DISEÑO">DISEÑO</option>
			  <option value="ECOLOGIA">ECOLOGIA</option>
			  <option value="EDITORIAL">EDITORIAL</option>
			  <option value="EDUCACION">EDUCACION</option>
			  <option value="ELECTRODOMESTICOS">ELECTRODOMESTICOS</option>
			  <option value="ELECTRONICA">ELECTRONICA</option>
			  <option value="ENERGIA">ENERGIA</option>
			  <option value="ENTE REGULADOR">ENTE REGULADOR</option>
			  <option value="ENTRETENIMIENTO">ENTRETENIMIENTO</option>
			  <option value="ESCRIBANIA">ESCRIBANIA</option>
			  <option value="FARMACEUTICA">FARMACEUTICA</option>
			  <option value="FONDO DE INVERSION">FONDO DE INVERSION</option>
			  <option value="FORESTAL">FORESTAL</option>
			  <option value="FRIGORIFICO">FRIGORIFICO</option>
			  <option value="GASTRONOMIA">GASTRONOMIA</option>
			  <option value="GOBIERNO">GOBIERNO</option>
			  <option value="GRAFICA">GRAFICA</option>
			  <option value="HIGIENE Y PERFUMERIA">HIGIENE Y PERFUMERIA</option>
			  <option value="HOLDING">HOLDING</option>
			  <option value="HOTELERIA">HOTELERIA</option>
			  <option value="IMPRENTA">IMPRENTA</option>
			  <option value="INDUSTRIA">INDUSTRIA</option>
			  <option value="INFORMACION E INVESTIGACION">INFORMACION E INVESTIGACION</option>
			  <option value="INMOBILIARIA">INMOBILIARIA</option>
			  <option value="INTERNET">INTERNET</option>
			  <option value="JURIDICA">JURIDICA</option>
			  <option value="LABORATORIO">LABORATORIO</option>
			  <option value="MADERERA">MADERERA</option>
			  <option value="MANOFACTURA">MANOFACTURA</option>
			  <option value="MEDICINA PREPAGA">MEDICINA PREPAGA</option>
			  <option value="MEDIOS">MEDIOS</option>
			  <option value="METALMECANICA">METALMECANICA</option>
			  <option value="METALURGICA">METALURGICA</option>
			  <option value="MINERIA / PETROLEO /GAS">MINERIA / PETROLEO /GAS</option>
			  <option value="MUEBLERIA">MUEBLERIA</option>
			  <option value="NAVIERA">NAVIERA</option>
			  <option value="NEUMATICO / CAUCHO">NEUMATICO / CAUCHO</option>
			  <option value="ORGANIZACIÓN INTERNACIONAL">ORGANIZACIÓN INTERNACIONAL</option>
			  <option value="ORGANIZACIONES NO GUBERNAMENTALES">ORGANIZACIONES NO GUBERNAMENTALES</option>
			  <option value="PAPELERA">PAPELERA</option>
			  <option value="PESCA">PESCA</option>
			  <option value="PETROQUIMICA">PETROQUIMICA</option>
			  <option value="PINTURAS">PINTURAS</option>
			  <option value="PLASTICOS">PLASTICOS</option>
			  <option value="PODER JUDICIAL">PODER JUDICIAL</option>
			  <option value="PRODUCTOS PARA LA CONSTRUCCION">PRODUCTOS PARA LA CONSTRUCCION</option>
			  <option value="PUBLICIDAD / MARKETING / RRPP">PUBLICIDAD / MARKETING / RRPP</option>
			  <option value="QUIMICA">QUIMICA</option>
			  <option value="RETAIL">RETAIL</option>
			  <option value="SALUD">SALUD</option>
			  <option value="SEGURIDAD">SEGURIDAD</option>
			  <option value="SEGUROS">SEGUROS</option>
			  <option value="SERVICIOS">SERVICIOS</option>
			  <option value="SERVICIOS PETROLEROS">SERVICIOS PETROLEROS</option>
			  <option value="SERVICIOS PUBLICOS">SERVICIOS PUBLICOS</option>
			  <option value="SIDERURGIA">SIDERURGIA</option>
			  <option value="SUPERMERCADO / HIPERMERCADO">SUPERMERCADO / HIPERMERCADO</option>
			  <option value="TABACALERA">TABACALERA</option>
			  <option value="TECNOLOGIA">TECNOLOGIA</option>
			  <option value="TELECOMUNICACIONES">TELECOMUNICACIONES</option>
			  <option value="TEXTIL">TEXTIL</option>
			  <option value="TRANSPORTADORA">TRANSPORTADORA</option>
			  <option value="TRANSPORTE / LOGISTICA / DISTRIBUCION">TRANSPORTE / LOGISTICA / DISTRIBUCION</option>
			  <option value="TURISMO">TURISMO</option>
			  <option value="OTRA">OTRA</option>
		    </select></td>
		  </tr>
		<tr align="left">
			<td>Titulo Obtenido:</td>
			<td><input name="titulo" type="text" class="text" minlength="2" tabindex="15"></td>
			<td>Cargo:</td>
			<td><select name="cargo" tabindex="18">
			  <option value="GERENCIA / ALTA GERENCIA / DIRECCION">GERENCIA / ALTA GERENCIA / DIRECCION</option>
			  <option value="JEFE / SUPERVISOR / RESPONSABLE">JEFE / SUPERVISOR / RESPONSABLE</option>
			  <option value="SENIOR / SEMI-SENIOR">SENIOR / SEMI-SENIOR</option>
			  <option value="JUNIOR">JUNIOR</option>
			  <option value="OTROS">OTROS</option>
		    </select></td>
		  </tr>
		<tr align="left">
			<td>&nbsp;</td>
			<td width="193">&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
		  <td colspan="4"><div align="center">
		    <input name="enviar" type="submit" value="Enviar">
		    <input name="borrar" type="reset" value="Borrar">
		    <input name="button" type="button" onclick="history.back(-1)" value=" Volver">
		    </div></td>
		  </tr>
	</tbody></table>
	
<script>
document.write("<input type=\"hidden\" name=\"js\" value=\"1\"");
</script>
</fieldset>
</form>
            <?php
            if (isset($_POST['submit'])) {
                require("registro.php");
            }
            ?>
</body>
</html>